Can't up to 2 grains successfully?

On wk 8 of NDT after initially thinking I had raised too quickly and feeling rubbish on 2 grains I started again. Once again I feel ill on 2 grains, run down, headache tiredness, dry/sore eyes aches and pains. Felt really good before this point.

I was optimal on Levo according to my full thyroid blood results (didn't feel it) prior to changing over so thought it would all be more of a seamless transition. Is it possible to be optimal on 1.5 grains or is this potentially a sign of cortisol/adrenal issues? I take B12, Vit D, Magnesium, B complex and liquid iron .

26 Replies

  • What about one and three quarter grains? I know it seems a tiddly amount to quibble over, a quarter of a grain, but I've known people to have a sweet spot. It might be that the jump up of half a grain in one go is just too much.

  • And having read your other posts now - how much Levo were you on prior to switching over? There's rarely an exact correlation but it'll offer a clue to how much you might need (assuming you weren't as well as you'd have liked to be while on Levo). Do also bear in mind that your hormones will be sorting themselves out after pregnancy, so there are a few variables in the mix!

  • I was on 100mcg and got a full thyroid panel done. My results were pretty impressive considering I was on Levo but still had the usual systems. Not sure if I posted them in here too?

  • Symptoms* I got a full thyroid panel done prior to making the change.

  • Stick with what makes you feel best. That's the important thing.

    It may also depend on the brand of NDT. I was on 2 grains of Erfa, but changed over recently to Nature Throid which is a little bit stronger. So far that seems to work better for me if I take 1.75 grains.

    You may also find you can take 2 grains in the winter when it's colder, but need less in hot weather.

  • I am on wp thyroid. I feel good on 1 grain split between am and pm.

  • I couldn't get over 1½ NT either, then was put on 100mcg levo (after 5 months).

    On the NatureThroid site there's a graph saying 1 grain is bio-equivalent to 100mcg T4 (38T4, 9T3 if memory is correct - T3 is c. 4x 'stronger') but some say it's more.

    Do you feel better on 1½ grains?

  • Yeah I do, feel well on 1 grain to be honest. x

  • Do you take it all in one go? If not, perhaps if you take it in two doses this would spread out the T3 more so you wouldn't get symptoms of over treatment?

  • It's best to let your body dictate how much hormones it needs. I've done the same and increased and didn't realise some symptoms were caused by too much.

    Drop down the dose gradually till symptoms resolve and remain on that dose. If you drop by 1/4 tablet each time rather than too much.

    You say you were on 100mcg of levo and 2 grains of NDT are equal to about 200mcg of levo, so it does sound as if you are overdosed.

  • Sorry a bit confused.. Was reading thyroiduk website and it says one grain (including obvious variations due to brand) was equivalent to 38mcg t4 and about 8/9mcg t3. What makes you say 1 grain - 100mcg t4? I ask because I will once again be transitioning back on to ndt at some point in the future and this has confused me uptil now. Thanks

  • Chloe, most go by a version of this:

    Personally, I don't think a grain is = 100mcg, as most people seem to end up on between 2-3 grains. Though the other way of looking at that is that 100mcg is actually a really conservative dose and we should've been on more of it in the first place! Years ago, we were dosed according to symptoms, not to numbers in a lab test result...

  • It may be that your situation is such that you won't be able to push your FT4 very high in the normal range; some of us just don't convert efficiently. If you find you feel pretty good on 1.5 grains, you might feel even better if you filled in with a little extra T3. The only sure way to determine if T3 might help, would be to do an FT3 test. If you don't have access to testing, you can compute suggested doses from T3:T4 ratio, T3 power factor, and T4-only full replacement value (see my postings).

  • I am not sure, these were my results 8 wks ago on 100mcg of Levo

    T4 - 123 58-161 nmol/L

    TSH- 0.01 0.40-4.00 mlU/L

    FT4 -17.0 11.5-22.7 pmol/L

    FreeT3 -5.4 2.8-6.5 pmol/L

    FT4: FT3 ratio - 3.1 2.0-4.5 ratio

    Reverse T3- 0.28 0.14-0.54 nmol/L

    Thyroglobulin <20 <=40 IU/ml

    Peroxidase <10 <=35 IU/ml

  • Whoa. TSH=0.01 is too low. I'd be jumping out of my skin were mine that low! Have you ever been on the next dose down (88mcg) of levo, and if so, how do you feel at that dose?

  • I am now on ndt and think this is why I can't manage 2 grains. I feel well at around the 1 grain to 1.5 grain anything more and I feel rundown. My TSH has always been around this mark but I thought it was good to have it supressed like this?

  • There seems to be general agreement that TSH should not be that low. The AACE range is 0.3-3.0. I've seen one alternative practitioner say that 0.1 is OK. One of the pharmacists mags printed a meta-study in which they concluded that Bad Things start to happen when TSH<0.04. Personally, I have felt really bad when I've had TSH<.015 (the lower limit recognized by the lab I used then). Currently TSH=0.47 and I feel quite well there; FT3 is about mid-range with that TSH.

  • Interesting. I've suspected for a while that one of the reasons I feel so unwell is largely to do with an overly supressed TSH (my last labs were 0.01, and that was an increase!)

    My TSH does have to be supressed to an extent as I previously had THyCa, but my Endo agrees it could be higher. Any sources for those studies on low TSH? Thanks.

  • The American Pharmacists Association ( published a study on their web some years back, claiming that TSH<0.04 is where Bad Things start to happen. For reasons unknown, they have removed that article from their web site.

  • Just wanted to mention that many people do well with a totally suppressed TSH. My own thyroid doctor (who is thyroid-less and takes t3 because she did horribly on Levo) has described her TSH to me as ".0000something."

  • Yeah mine has pretty much always been supressed on Levo anyway awaiting blood results for NDT think it will be the same. I am on 1.5 grains at the minute may try and raise to a quarter and see how I feel. x

  • Some people with Hashimotos get worse on made me very ill.

  • I don't have hashis think I am just optimal at a lower dose but will find out when I get my next blood work done.

  • Just don't depend too much on blood work. The ideal way, not the doctors way, is to raise until symptoms are eliminated.

  • I agree, I do feel well on the lower end of ndt and its quite remarkable the change from feeling great on 1.5 and feeling awful on 2. So will just go back once again to 1 grain and move up by a quarter to find out exactly where I feel optimal.

  • good idea.

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